ALCOHOLIC LIVER DISEASE

Question 0

What is alcoholic liver disease?

Answer 0

Spectrum of chronic liver disease including

• alcoholic fatty liver disease
• alcoholic hepatitis (balloon degeneration, spotty necrosis, PMN infiltrate and fibrosis in space if Disse)
• cirrhosis

Question 1

What LFT changes?

Answer 1

AST:ALT > 2, markedly elevated GGT

Question 2

What is mortality of alcoholic hepatitis?

Answer 2

40% in 6 months

Question 3

Risk factors for alcoholic liver disease?

Answer 3

Amount and duration of alcohol intake 
Female 
HCV infection 
FHx 
Protein-calorie malnutrition 
OBESITY AND BINGE DRINKING (minor)

Question 4

S + S of alcoholic fatty liver?

Answer 4

Usually asymptomatic with normal exam +/- hepatomegaly.

Question 5

What lab Ix for alcoholic fatty liver disease?

Answer 5

High GGT
AST:ALT > 2
Macrocyclic anemia: B12/folate deficiency, alcoholism
Thrombocytopenia: congestive Spleenomegaly, BM hypoplasia

Question 6

S + S of alcoholic hepatitis?

Answer 6

ABDO pain - epigastric or RUQ 
JAUNDICE
FEVER
ANOREXIA
ENCEPHALOPATHY
Stigmata of chronic liver disease
- palmar erythema 
- dupuytrens contracture
- spider naevi
- bilateral parotidomegaly 
- bilateral gynaecomastia
- testicular atrophy

Question 7

Complications of chronic alcohol consumption?

Answer 7

Later

Question 8

Ix - LAB?

Answer 8

CBE - anaemia, thrombocytopenia
EUC - electrolytes, hypervolemic and hyponatremic
Hep serology
Antibodies for autoimmune hep - ANA, total IgG, anti-smooth muscle antibody

Question 9

Rad investigations?

Answer 9

LIVER US
+/- CT/MRI

Portal pressure measurement

Liver biopsy

Question 10

Where do the liver enzymes originate?

Answer 10

AST - RBC, cardiac and skeletal muscle
ALT - muscle
GGT - liver, biliary tree, kidney, pancreas, brain and more
ALP - liver bone placenta

Question 11

What if raised GGT and ALP?

Answer 11

Cholestatic

Question 12

Raised ALT AST?

Answer 12

Hepatic

Question 13

Raised GGT?

Answer 13

ALCOHOL

Question 14

Raised ALP?

Answer 14

Bone disease

Question 15

AST:ALT > 2:1?

Answer 15

Alcoholic liver disease

Question 16

Management of liver cirrhosis?

Answer 16

Complete abstinence from alcohol
Non-pharm (all dietary) 
- supplement thiamine, multivitamin 
- high calorie, high protein diet 
- avoid salt if ascites 

Pharm
Correct metabolic derangements
- correct electrolytes
- glucose: thiamine before glucose to avoids Wernickes
- INR prothrombin or FFP because does not respond to parenteral vitamin K

Management of withdrawal Sx
- agitation, seizures or delirium tremens with PO diazepam